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Reumato Flashcards

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1
Q

Gene care influenteaza susceptibilitatea la SA

A

IL-1IL-23CYP2D6ERAP-1

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2
Q

Criterii lombalgie SA

A

Varsta diagnostic < 45 aniDebut insidiosAmeliorare la efortLipsa ameliorare la repausDurere nocturna cu ameliorare la ridicare4/5 = Sb 80%

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3
Q

Manifestari extraarticulare in SpA

A

UveitaLeziuni cutanate identice histologic cu psoriazis pustulos - AReDistrofie unghiala - APs, AReAortita - SA, ARe

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4
Q

Ce masoara testul Schober

A

Rigiditatea spinala

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5
Q

Manifestari uveita anterioara acuta

A

Durere oculara severaFotofobieVedere incetosata

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6
Q

Ce evalueaza scorul BASDAI

A

ObosealaDurerea spinalaArtralgiaTumefactia articularaSensibilitatea localizataTendinita/entezitaDurata si severitatea redorii matinale

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7
Q

Cum apare coloana de bambus pe Rx

A

Calcificarea lig intervertebraleFuziunea articulatiilor dintre apofizele spinoaseSindesmofite

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8
Q

Ce determina entezita de la nivelul insertiei ligamentelor intervertebrale?

A

Formare de sindesmofiteAnchiloza osoasaRigidizare permanenta

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9
Q

Blocanti TNF-alfa utili in SA

A

InfliximabEtanerceptAdalimumabGolimumabCertolizumab

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10
Q

Variante de antiinflamatoare in SA

A

AINSBlocanti de TNF-alfaBlocanti de IL-17Sulfasalazina (doar pentru artrita periferica; nu are efect pe artrita axiala)

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11
Q

DMARDs utile in APs

A

Blocanti de TNF-alfa - etanercept, golimumabInhibitori de IL-17 - secukinumab, ixekizumabInhibitori de IL-12/23 - ustekinumabInhibitori de PDE4 - apremilastInhibitori de JAK - tofacitinib

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12
Q

Ce determina artrita psoriazica mutilanta?

A

Osteoliza periarticulara marcataScurtarea oaselor (degete telescopate)

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13
Q

Frecventa HLA DR4 la cei cu PAR

A

50-75%

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14
Q

Frecventa FR la cei cu PAR

A

75-80%

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15
Q

Ce citokine sunt sintetizate dupa depunerea de complexe imune in membrana sinoviala?

A

Macrofagele -> IL-1, IL-8, TNF-alfa, GM-CSFFibroblastele -> IL-6

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16
Q

Ce molecule prezinta fibroblastele sinoviale si ce faciliteaza ele?

A

VCAM-1 - sustin supravietuire si diferentierea LBDAF - previne liza celulara indusa de CCaderina II - mediaza interactiunile celulareAceste molecule faciliteaza formarea de tesut limfoid ectopic in membrana sinoviala

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17
Q

Ce produc LTh17

A

IL-17IL-21IL-22TNF-alfa

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18
Q

Ce autoantigene se citrulineaza in organism? (Care sunt factorii declansatori pentru formarea de ACPA)

A

FilagrinaVimentinaColagen tip 2

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19
Q

Semnificatia unui titru FR persistent crescut in boala precoce

A

Sinovita persistent activaImplicarea mai multor articulatiiDizabilitate mai importanta

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20
Q

Factori de prognostic negativ in PAR

A

Varsta inaintataSex FFumatComorbiditatiRedoare matinala > 30 min> 4 articulatii tumefiateAfectare simetrica a articulatiilor miciPCR > 20 g/dLFR, ACPA +

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21
Q

DDx PAR precoce

A

SpA
PMR
Artroza nodulara acutizata
Artita postvirala: rubeola, eritrovirus, VHB

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22
Q

Ce articulatii afecteaza PAR precoce?

A

Frecvent IFP, MCF, MTFPosibil si carp, cot, umar, glezna, genunchiIFD crutate de obicei

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23
Q

Prezentare rara a PAR (10% cazuri)

A

Monoartrita genunchi/umar/STC

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24
Q

Tipuri de afectare clinica in PAR

A

PalindromicaTranzitorieRemisivaCronicaRapid progrsiva

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25
Cum se prezinta compresia medulara in PAR constituita?
Dificultate de mers care nu poate fi explicata prin boala articularaSlabiciunea picioarelorPierderea controlului sfincterian
26
Ce alte articulatii mai sunt afectate in PAR?
Coloana cervicalaATMAcromio-clavicularaSterno-clavicularaCrico-aritenoidaOrice alta articulatie sinoviala
27
Factori de risc pentru vasculita in PAR
FR titruri mariManifestari extra-articulare active in alte parti
28
Frecventa HLA DR4 in sindrom Felty
95%
29
Complicatii sindrom Felty
Ulcere picioareSepsis
30
Cand trimitem un pacient cu PAR la reumato?
Afectarea articulatiilor mici (maini/picioare)Afectarea a >1 articulatieDebut > 3 luni
31
Ce determina osteoporoza juxta-articulara in timpul sinovitei active?
Citokinele locale (de la nivelul membranei sinoviale)Imobilizarea articulatiei
32
Manifestari non-articulare in PAR
Sclerita/EpiscleritaScleromalacieSindrom Sjogren - xeroftalmie, xerostomieLimfadenopatieBursita olecraniana, noduli subcutanatiTenosinovita flexorilorTumefactia tecii tendonului extensor al degetelorSTCNeuropatie senzitivo-motorieSubluxatie atlanto-axiala -> rar determina compresie medularaLeziuni de vasculita unghialaUlcere gambiereEdem de glezneAmiloidozaPericarditaPleurezie, BIP, sindrom Caplan, noduli reumatoizi, bronsiolita obliteranta (boala de cai aeriene mici)Sindrom Felty (splenomegalie + neutropenie)Anemie
33
Anticorpi umani (bDMARDs)
AdalimumabGolimumab
34
Anticorpi umanizati (bDMARDs)
EtanerceptCertolizumab
35
bDMARDs cu administrare s.c
EtanerceptCertolizumabAdalimumabGolimumabTocilizumabSarilumab
36
bDMARDs cu administrare i.v
InfliximabRituximabAbataceptTocilizumab
37
RA Anti-TNF
Reactii la locul injectariiReactii de HSSindrom lupus-likeInfectiiICDemielinizare, sindroame autoimune (rar)
38
Ce biologice au biosimilare?
InfliximabEtanerceptAdalimumabRituximab
39
Tintele chirurgiei in PAR
Profilactice - previne distrugerea articulara si deformareaReconstructive - restabileste functia articulara
40
Optiuni chirurgicale in PAR
SinovectomieRefacerea tendoanelorOsteotomie de realiniere a suprafetelor portanteArtrodeza (fuziunea articulatiei) - pentru articulatiile deteriorate care nu sunt usor de inlocuitArtroplastie de implant al articulatiilor mici (MCF)Artroplastie de excizie ale capetelor metatarsiene - reduce durerea metatarsianaArtroplastie totala - umar, cot, carp, sold, genunchi, glezna - reduce durerea si imbunatateste functia articulara
41
Modalitatile prin care HLA B27 creste riscul de ARe
Selectarea receptorilor LTMimetism molecularModul de prezentare a peptidelor derivate din bacterii catre LT
42
Ce artrita poate fi reactiva sau septica?
PoststreptococicaGonococicaBruceloza
43
Manifestari clinice ale ARe
Conjunctivita sterilaUlceratie oralaUretritaBalanita circinataArtrita de genunchiSinovita de MTFDactilitaEntezita -> fasceita plantara, tendinoza ahilianaKeratoderma blenorrhagica plantara
44
Hiperuricemie patologica
> 6,86 mg/dLSau> 408 mcmoli/L
45
AUS creste cu
VarstaGreutateaO dieta occidentalaDislipidemie mixta + DZBCIHTA
46
Ce transportori sunt responsabili de excretia renala de acid uric?
Antiporter anion-urat (reabsorbtie)Transportor de reabsorbtie a uratuluiTransportoare de anioni secretoriProteine transportoare de fosfat de sodiuPompa secretorie cu motor ATP
47
Ce transportor de urat este prezent si in rinichi si in intestin?
Transportorul secretor ABCG2
48
Cauze de hiperuricemie - afectarea excretiei acidului uric
BCRHTAHPTH primar, hipotiroidismSaturnismMedicamente - diuretice tiazidice, aspirina (doze mici)Cresterea productiei de acid lactic - alcool, exercitii fizice, infometareDeficit de glucozo-6-fosfataza
49
Cauze de hiperuricemie - cresterea productiei
Deficit de HGPRT - Lesch Nyhan (X linkata)Deficit de glucozo-6-fosfataza - glicogenoza tip 1Hiperactivitatea fosforibozil-pirofosfat sintazei
50
Cauze de hiperuricemie - metabolism crescut al purinelor
Boli mieloproliferative - policitemia veraBoli limfoproliferative - leucemieCarcinoamePsoriazis sever
51
Caracteristici guta cronica tofacee poliarticulara
Artralgii croniceLimitarea activitatiiLeziuni articulare structuraleAtacuri frecvente
52
Ce poate precipita un atac de guta?
Exces alimentarAlcoolDeshidratareDiuretice
53
Punctul de saturatie al acidului uric
6,05 mg/dLSau360 mcmoli/L
54
Scopul tratamentului in guta
AUS < 360 mcmoli/L SAU 6.05 mg/dL la totiSAUAUS < 300 mcmoli/L SAU 5.04 mg/dL la cei cu guta severa (tofi/atacuri frecvente)
55
Cele mai frecvente RA la alopurinol
Eruptii cutanateIntoleranta GI
56
RA grave, dar rare ale alopurinolului
HSSupresie medulara
57
Unde se formeaza tofi?
PeriarticularPe urechePe degeteLa nivelul tendonului ahilianSunt depozite subcutanate, albe, netede
58
Prevalenta condrocalcinozei creste cu
VarstaPrevalenta artrozeiPrevalenta traumatismelor/leziunilor articularePrevalenta bolilor metabolice - HPTH, hemocromatoza, hipoMg-emie
59
Locuri preferentiale de debut in guta, condrocalcinoza
Guta - MTF 1Condrocalcinoza - genunchi, carp
60
Diferenta microscopica guta vs condrocalcinoza
Guta - cristale in forma de ac, fara birefringenta - UMSCondrocalcinoza - cristale romboidale, cu birefringenta - PFCD
61
Cum determina leziuni articulare cristalele de FCB
Induce proliferarea fibroblastelorCitokine proinflamatorii - IL-1beta, TNF alfaOxid nitricMetaloproteinaze
62
DDx boala prin depunere de FCB
GutaCondrocalcinozaArtrita septicaCelulita
63
Coloratie specifica pentru Calciu
Alizarin rosu S
64
Medicamente care pot induce LES
HidralazinaIzoniazidaProcainamidaPenicilaminaForme usoareNU dau afectare neurologica/renala
65
Cand creste PCR in LES?
Pleurezie lupicaPeritonitaArtritaInfectie coexistenta
66
Markeri predictivi pentru puseu de LES
VSH mareAc anti-ADNdc crescutiC3 mic
67
Manifestari neurologice in LES
Depresie usoaraPsihozaBoli cerebrovasculareHemiplegieEpilepsieAtaxie cerebeloasaPolineuropatieAfectarea NCMigreneMeningita septica
68
Manifestari clinice in LES + procente
Articulatii (90%) - artrita de articulatii mici, rar NACFTegument (85%) - eritem in fluture, fotosensibilitate, vasculita, purpura, urticarieHematologic (75%) - anemie (Ncr, Nc sau hemolitica Coombs+), leuco/limfopenie, trombocitopenieSN - vezi flashcard manifestari neuroGeneral - fatigabilitate (75%), febra (50%), scadere ponderala (50%), depresieTorace (50%) - pleurezie/efuziune, disfunctie respiratorie restrictiva (rar)Renal (30%) - glomerulonefritaCord - pericardita, endocardita Libman Sacks, leziuni de valva aortica, miocardita cu aritmiiRaynaud (20%)Dureri abdominale (20%)Ochi - Sjogren (15%), episclerita, conjunctivita, nevrita opticaMiozita (<5%)
69
Sindrom lupic neonatal - clinica
EruptiiHepatitaBloc cardiac fetal
70
Ce manifestari din LES raspund la antimalarice?
ArtralgiiFatigabilitateAfectare cutanata
71
Ce manifestari din LES raspund la AINS in doze standard?
ArtralgiiArtritaSerozitaFebra

Rezi FC (29 decks)

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